Prone Positioning of Patients With Acute Respiratory Distress Syndrome Related to COVID-19: A Rehabilitation-Based Prone Team

Ng, Jillian A; Miccile, Lauren A; Iracheta, Christine; Berndt, Carolyn; Detwiller, Meredith; Yuse, Carolyn; Tolland, Joseph

OBJECTIVE: Prone positioning is an effective intervention for acute respiratory distress syndrome (ARDS). An increasing number of patients with ARDS related to coronavirus disease 2019 (COVID-19) required prone positioning, which posed a challenge to the intensive care unit (ICU) staff at Brigham and Women’s Hospital. METHODS (CASE DESCRIPTION): A prone team service of physical therapists and occupational therapists with critical care experience was established to assist with increasing demands for prone positioning of patients who were mechanically ventilated. The goals of the rehabilitation-based prone team were to provide support to nursing and respiratory therapy; create a consistent, efficient process; and ensure patient and staff safety. RESULTS: The service evolved over 7 weeks, expanding to 24-hour coverage and adding responsibilities to support the staff as patient volume grew. Volume of requests to the rehabilitation-based prone team generally increased to week 4 and has since then declined. Key points for successful implementation included identification of rehabilitation therapists with ICU experience and leadership qualities, multidisciplinary collaboration, availability of needed positioning devices and supplies to protect the integument, and well-defined roles of all disciplines participating in position change process. CONCLUSION: The description of the development, operations, evolution, and utilization of a rehabilitation therapist prone team acts as a guide for future development and implementation. IMPACT: This case report is one of the first reports of a rehabilitation-based prone team established to assist with positioning patients in prone as an intervention for ARDS related to COVID-19 and will help guide other institutions.